Provider First Line Business Practice Location Address:
US DENTAL ACTIVITY
Provider Second Line Business Practice Location Address:
BLDG 171 4TH INNER LOOP RD
Provider Business Practice Location Address City Name:
FORT IRWIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92310-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-380-3166
Provider Business Practice Location Address Fax Number:
760-380-4996
Provider Enumeration Date:
01/23/2006